Is a mass immunization program for pandemic (H1N1) 2009 good value for money? Evidence from the Canadian Experience
ABSTRACT In response to the pandemic H1N1 influenza 2009 outbreak, many jurisdictions undertook mass immunization programs that were among the largest in recent history. The objective of this study was to determine the cost-effectiveness of the mass H1N1 immunization program in Ontario, Canada's most populous province (population 13,000,000). This analysis suggests that a mass immunization program as carried out in Ontario and many other high-income health care systems in response to H1N1 2009 was effective in preventing influenza cases and health care resource use and was also highly cost-effective despite the substantial program cost.
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ABSTRACT: We analyzed the effects of the timing of vaccine distribution in 11 U.S. states during the 2009 H1N1 influenza pandemic. By using reported data on the fraction of patients presenting with flu-related symptoms, we developed a transformation that allowed estimation of the state-specific temporal flu wave curve, representing the number of new infections during each week. We also utilized data describing the weekly numbers of vaccine doses delivered and administered. By using a simple difference equations model of flu progression, we developed two influenza wave curves: first, an "observable" curve that included the beneficial effects of vaccinations, and second, an unobservable curve that depicted how the flu would have progressed with no vaccine administered. We fit the observable curve to match the estimated epidemic curve and early exponential growth associated with R0, the reproductive number. By comparing the number of infections in each scenario, we estimated the infections averted by the administration of vaccine. Southern states experienced peak infection several weeks before northern states, and most of the vaccine was delivered well after the peak of the southern flu wave. Our models suggest that the vaccine had minimal ameliorative impact in the southern states and measurable positive impact in the northern states. Vaccine delivery after peak also results in a smaller fraction of the population's seeking the vaccine. Our analysis suggests that current Centers for Disease Control and Prevention policy of allocating flu vaccine over time in direct proportion to states' populations may not be best in terms of averting nationally the maximum possible number of infections.Value in Health 01/2012; 15(1):158-66. DOI:10.1016/j.jval.2011.07.014 · 2.89 Impact Factor
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ABSTRACT: Background: The first pandemic of the millennium was declared in June 2009. At that time, the pH1N1 virus was already in circulation in Canada and early reports from around the world indicated a potentially severe pandemic. The initial projections did not materialize but it was not clear whether this was due to the nature of the virus, or the success of public health initiatives. The objective of this analysis was to examine the effectiveness of the interventions used in Canada from both a health and economic point of view. Methods and Findings: A mathematical model was fitted to the observed Canadian hospitalizations and deaths including the reported antiviral and vaccine interventions. In addition to the number of infections, hospitalizations, deaths and quality adjusted life years (QALYs) lost, the model also determined the indirect economic impact on GDP driven by absenteeism. The model yielded an attack rate of 15%. By turning off the interventions, the potential impact of the unmitigated pH1N1 pandemic was evaluated and found to have an attack rate of 28%. The interventions reduced hospitalizations by 55%, deaths by 74%, QALYs lost (3% discounted) by 69% and the GDP impact by 49%. In 2009 dollars, the net cost of the combined antiviral and vaccine intervention was $11,145 per QALY gained indicating that the interventions were very cost-effective. This includes costs saved from the reduced hospitalizations and doctor visits. Conclusions: Without the reported use of antivirals and vaccine during 2009 in Canada, the analysis indicated that the pandemic impact of pH1N1 could have had an attack rate of 28%, twice the hospitalizations and GDP impacts, almost three times the hospitalization costs and QALYs lost; and almost four times the number of deaths. Such pandemic intervention policies were also very cost-effective with an incremental cost-effectiveness ratio of $11,145 per QALY gained.
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ABSTRACT: The processing of extreme high bit rates (⩾20 Gbit/s) or signal frequencies (⩾20 GHz) is of increasing importance for advanced telecommunications. Therefore a suitable circuit arrangement is necessary. Problems like frequency dispersion of microstrip lines, frequency dependence of parasitic impedances, and transforming characteristics of any finite length of layer must be solved. For this purpose a chip-in-board embedding technique with integrated film capacitors was developed. The article describes the manufacturing of such thin film hybrid circuits containing planar capacitors and feed-through capacitors. The chip interconnection technology is represented tooRadio and Wireless Conference, 1998. RAWCON 98. 1998 IEEE; 09/1998